1. Field of the Invention
This invention pertains generally to instruments and techniques for establishing surgical airways, and more particularly to a method and apparatus for emergency surgical cricothyrotomy.
2. Description of the Background Art
During medical emergencies, there is an important need to access and control the patient's airway. A lack of oxygen to the patient, even for a brief period of time, may prove fatal. Patients who are inflicted with upper airway obstructions generally receive a surgical airway when non-invasive techniques fail to clear their upper airway. There are generally three common approaches to creating a surgical airway: needle tracheotomy, standard tracheotomy, and cricothyroidotomy (also known as cricothyrotomy).
Needle tracheotomy involves insertion of a large-bore needle into the patient's trachea to allow the patient to breathe. This procedure is, for the most part, unrealistic because the largest commonly available needle in the hospital setting is approximately fourteen gauge. This small size generally fails to provide adequate airflow capacity to a patient suffering from trauma.
Standard tracheotomy involves making two incisions, one immediately following the other, which must penetrate into the trachea. This often results in excessive bleeding and thus is a disfavored approach.
Cricothyrotomy has replaced the foregoing crude procedures to create an airway in the patient's trachea. Cricothyrotomy became established as the preferred method of surgical emergency management during the 1970s and early 1980s. It is easier to learn, quicker to perform, and is overall a safer procedure for the emergency medical physician who performs surgical airways very infrequently. Cricothyrotomy is performed by creating an opening in the cricothyroid membrane. The airway lies anterior to the esophagus and the cervical spine and is usually located in the midline of the neck. The surface anatomy of the neck is easily recognizable; in the anterior part of the neck, the anatomic landmarks include the hyoid bone, the thyroid cartilage, the cricoid cartilage, and the tracheal rings.
The general procedure for surgical cricothyrotomy is as follows: (1) locate the cricothyroid membrane; (2) make a vertical skin incision over the cricothyroid membrane; (3) stabilize the larynx with a tracheal hook while an incision is made in the cricothyroid membrane; (4) enlarge the incision in the cricothyroid membrane using hemostats or the blunt end of a scalpel; and (5) insert a tracheotomy tube between the curved hemostats. This surgical procedure requires, at minimum, the following tools: (1) a scalpel for making the incision; (2) a tracheal hook to stabilize the larynx; (3) a hemostat or second scalpel to enlarge or dilate the incision in the cricothyroid membrane; and (4) a tracheotomy tube to allow passage of air into the airway.
Because a surgical cricothyrotomy is done during an emergency where there is little or no preparation time available, there exists a need to minimize the number of instruments required by the emergency room physician and simplify the procedures involved, thus increasing the probability of saving the patient's life. The present invention satisfies those needs, as well as others, and overcomes the deficiencies inherent in coventional techniques and instruments.